Eligibility Determination

The Eligibility Determination – Autism contains one tab:

To create an Eligibility Determination – Autism document:

Enter the Document Date (MMDDYY) or click and select date. This should reflect the date the document was created.
Respond to the statements by selecting Yes or No from the drop-downs.
If either response is Yes, provide an explanation in the textbox.
Use to spellcheck.
Use for more space.

The Eligibility Criteria contains checkboxes that determine if the student meets the criteria for eligibility.

Check the appropriate Eligibility Criteria that apply.
Based on the criteria selected, indicate the decision of whether the student is or is not eligible using the drop-down selection.

Check the Sources of Data Used to Make this Decision.
Enter the current IEP (Date) (MMDDYY) or click and select date.

Add any Other source of data used to make this decision that might apply.

Check Student to include the student's name as a participant. If the checkbox is left blank the name will not be included as a participant.
On the Parents section, check Participant, to include each parent/guardian name as a participant. If these are left blank, the names will not be included as participants.

The Staff section displays the staff members who have been added to the student’s Team List. Names can be added or removed from the staff section of this document without affecting the student’s Team List. If a Staff name is added to this document, the name will display on this document only and not on the student’s Team List. Staff Names displaying will be included as participants, however changes may be made including additional staff names added.

Change current staff names:

Click next to the Staff Name to change. The Find: Staff screen displays.
Enter all or part of staff Last Name, First Name.
Click or press ENTER. Search Results displays a list of matching criteria.
Click line of staff name. Line highlights.
Click again or click . Find: Staff screen closes and staff name displays.

Click the Role and select the staff role.

Add staff names:

Click on the Staff bar. A new line is added to the grid.
Repeat the procedure above.
If needed, check on the line of the staff name to remove. The row is removed.

The Other Participants section will allow for participant names that are not available in the Staff directory.

Click on the Other Participants bar. A new row will be added.
Enter the Name and Job Title of the participant.
If needed, check on the line of the staff name to remove. The row is removed.
Use to spellcheck.
Use for more space.
The Contact Person displays staff member names from the Staff Participants list. Select the appropriate staff participant's name to display as the Contact Person.
Enter that person's Phone number.

The final section contains the DSM-IV Diagnostic Criteria for Autism Spectrum Disorder. Based on selections checked, the student is given a score that will provide an overview and explanation of the student’s Autism eligibility.

Check the statements that apply. The Total box at the bottom, displays the amount of items selected.
Click .
The document can be printed, validated and finalized.

GENAZ 57 Eligibility Determination - Emotional Disability

The Eligibility Determination – Emotional Disability contains one tab:

Eligibility Determination

To create an Eligibility Determination – Emotional Disability document:

Enter the Document Date (MMDDYY) or click and select date. This should reflect the date the document was created.
Respond to the statements by selecting Yes or No from the drop-downs.
If either response is Yes, provide an explanation in the textbox.
Use to spellcheck.
Use for more space.

The Eligibility Criteria contains checkboxes that determine if the student meets the criteria for eligibility.

Check the appropriate Eligibility Criteria that apply.

Based on the criteria selected, indicate the decision of whether the student is or is not eligible using the drop-down selection.

Check the Sources of Data Used to Make this Decision.
Enter the current IEP (Date) (MMDDYY) or click and select date.

Add any Other source of data used to make this decision that might apply.

Check Student to include the student's name as a participant. If the checkbox is left blank the name will not be included as a participant.
On the Parents section, check Participant, to include each parent/guardian name as a participant. If these are left blank, the names will not be included as participants.

The Staff section displays the staff members who have been added to the student’s Team List. Names can be added or removed from the staff section of this document without affecting the student’s Team List. If a Staff name is added to this document, the name will display on this document only and not on the student’s Team List. Staff Names displaying will be included as participants, however changes may be made including additional staff names added.

Change current staff names:

Click next to the Staff Name to change. The Find: Staff screen displays.
Enter all or part of staff Last Name, First Name.
Click or press ENTER. Search Results displays a list of matching criteria.
Click line of staff name. Line highlights.
Click again or click . Find: Staff screen closes and staff name displays.

Click the Role and select the staff role.

Add staff names:

Click on the Staff bar. A new line is added to the grid.
Repeat the procedure above.
If needed, check on the line of the staff name to remove. The row is removed.

The Other Participants section will allow for participant names that are not available in the Staff directory.

Click on the Other Participants bar. A new row will be added.
Enter the Name and Job Title of the participant.
If needed, check on the line of the staff name to remove. The row is removed.
Use to spellcheck.
Use for more space.
The Contact Person displays staff member names from the Staff Participants list. Select the appropriate staff participant's name to display as the Contact Person.
Enter that person's Phone number.
Click .
The document can be printed, validated and finalized.

GENAZ 58 Eligibility Determination - Hearing Impairment

The Eligibility Determination – Hearing Impairment contains one tab:

Eligibility Determination

To create an Eligibility Determination – Hearing Impairment document:

Enter the Document Date (MMDDYY) or click and select date. This should reflect the date the document was created.
Respond to the statements by selecting Yes or No from the drop-downs.
If either response is Yes, provide an explanation in the textbox.
Use to spellcheck.
Use for more space.

The Eligibility Criteria contains checkboxes that determine if the student meets the criteria for eligibility.

Check the appropriate Eligibility Criteria that apply.

Based on the criteria selected, indicate the decision of whether the student is or is not eligible using the drop-down selection.

Check the Sources of Data Used to Make this Decision.
Enter the current IEP (Date) (MMDDYY) or click and select date.

Add any Other source of data used to make this decision that might apply.

Check Student to include the student's name as a participant. If the checkbox is left blank the name will not be included as a participant.
On the Parents section, check Participant, to include each parent/guardian name as a participant. If these are left blank, the names will not be included as participants.

The Staff section displays the staff members who have been added to the student’s Team List. Names can be added or removed from the staff section of this document without affecting the student’s Team List. If a Staff name is added to this document, the name will display on this document only and not on the student’s Team List. Staff Names displaying will be included as participants, however changes may be made including additional staff names added.

Change current staff names:

Click next to the Staff Name to change. The Find: Staff screen displays.
Enter all or part of staff Last Name, First Name.
Click or press ENTER. Search Results displays a list of matching criteria.
Click line of staff name. Line highlights.
Click again or click . Find: Staff screen closes and staff name displays.

Click the Role and select the staff role.

Add staff names:

Click on the Staff bar. A new line is added to the grid.
Repeat the procedure above.
If needed, check on the line of the staff name to remove. The row is removed.

The Other Participants section will allow for participant names that are not available in the Staff directory.

Click on the Other Participants bar. A new row will be added.
Enter the Name and Job Title of the participant.
If needed, check on the line of the staff name to remove. The row is removed.
Use to spellcheck.
Use for more space.
The Contact Person displays staff member names from the Staff Participants list. Select the appropriate staff participant's name to display as the Contact Person.
Enter that person's Phone number.
Click .
The document can be printed, validated and finalized.

GENAZ 59 Eligibility Determination - Intellectual Disability

The Eligibility Determination – Intellectual Disability contains one tab:

Eligibility Determination

To create an Eligibility Determination – Intellectual Disability document:

Enter the Document Date (MMDDYY) or click and select date. This should reflect the date the document was created.
Respond to the statements by selecting Yes or No from the drop-downs.
If either response is Yes, provide an explanation in the textbox.
Use to spellcheck.
Use for more space.
Click the Disability Classification and make the appropriate selection.
Check if the Eligibility Criteria apply.

Based on the criteria selected, indicate the decision of whether the student is or is not eligible using the drop-down selection.

Check the Sources of Data Used to Make this Decision.
Enter the current IEP (Date) (MMDDYY) or click and select date.

Add any Other source of data used to make this decision that might apply.

Check Student to include the student's name as a participant. If the checkbox is left blank the name will not be included as a participant.
On the Parents section, check Participant, to include each parent/guardian name as a participant. If these are left blank, the names will not be included as participants.

The Staff section displays the staff members who have been added to the student’s Team List. Names can be added or removed from the staff section of this document without affecting the student’s Team List. If a Staff name is added to this document, the name will display on this document only and not on the student’s Team List. Staff Names displaying will be included as participants, however changes may be made including additional staff names added.

Change current staff names:

Click next to the Staff Name to change. The Find: Staff screen displays.
Enter all or part of staff Last Name, First Name.
Click or press ENTER. Search Results displays a list of matching criteria.
Click line of staff name. Line highlights.
Click again or click . Find: Staff screen closes and staff name displays.

Click the Role and select the staff role.

Add staff names:

Click on the Staff bar. A new line is added to the grid.
Repeat the procedure above.
If needed, check on the line of the staff name to remove. The row is removed.

The Other Participants section will allow for participant names that are not available in the Staff directory.

Click on the Other Participants bar. A new row will be added.
Enter the Name and Job Title of the participant.
If needed, check on the line of the staff name to remove. The row is removed.
Use to spellcheck.
Use for more space.
The Contact Person displays staff member names from the Staff Participants list. Select the appropriate staff participant's name to display as the Contact Person.
Enter that person's Phone number.
Click .
The document can be printed, validated and finalized.

GENAZ 60 Eligibility Determination - Multiple Disabilities / SSI

The Eligibility Determination – Multiple Disabilities /SSI contains one tab:

Eligibility Determination

To create an Eligibility Determination – Multiple Disabilities /SSI document:

Enter the Document Date (MMDDYY) or click and select date. This should reflect the date the document was created.
Respond to the statements by selecting Yes or No from the drop-downs.
If either response is Yes, provide an explanation in the textbox.
Use to spellcheck.
Use for more space.

The Eligibility Criteria contains checkboxes that determine if the student meets the criteria for eligibility.

Check the appropriate Eligibility Criteria that apply.

Based on the criteria selected, indicate the decision of whether the student is or is not eligible using the drop-down selection.

Check the Sources of Data Used to Make this Decision.
Enter the current IEP (Date) (MMDDYY) or click and select date.

Add any Other source of data used to make this decision that might apply.

Check Student to include the student's name as a participant. If the checkbox is left blank the name will not be included as a participant.
On the Parents section, check Participant, to include each parent/guardian name as a participant. If these are left blank, the names will not be included as participants.

The Staff section displays the staff members who have been added to the student’s Team List. Names can be added or removed from the staff section of this document without affecting the student’s Team List. If a Staff name is added to this document, the name will display on this document only and not on the student’s Team List. Staff Names displaying will be included as participants, however changes may be made including additional staff names added.

Change current staff names:

Click next to the Staff Name to change. The Find: Staff screen displays.
Enter all or part of staff Last Name, First Name.
Click or press ENTER. Search Results displays a list of matching criteria.
Click line of staff name. Line highlights.
Click again or click . Find: Staff screen closes and staff name displays.

Click the Role and select the staff role.

Add staff names:

Click on the Staff bar. A new line is added to the grid.
Repeat the procedure above.
If needed, check on the line of the staff name to remove. The row is removed.

The Other Participants section will allow for participant names that are not available in the Staff directory.

Click on the Other Participants bar. A new row will be added.
Enter the Name and Job Title of the participant.
If needed, check on the line of the staff name to remove. The row is removed.
Use to spellcheck.
Use for more space.
The Contact Person displays staff member names from the Staff Participants list. Select the appropriate staff participant's name to display as the Contact Person.
Enter that person's Phone number.
Click .
The document can be printed, validated and finalized.

GENAZ 61 Eligibility Determination - Other Health Impairment

The Eligibility Determination – Other Health Impairment contains one tab:

Eligibility Determination

To create an Eligibility Determination – Other Health Impairment document:

Enter the Document Date (MMDDYY) or click and select date. This should reflect the date the document was created.
Respond to the statements by selecting Yes or No from the drop-downs.
If either response is Yes, provide an explanation in the textbox.
Use to spellcheck.
Use for more space.

The Eligibility Criteria contains checkboxes that determine if the student meets the criteria for eligibility.

Check the box if this health impairment is documented by a doctor of medicine.
Enter the description in the textbox of the chronic or acute diagnosis which cause the following items (on the screen).
Check the appropriate Eligibility Criteria that apply.
Based on the criteria selected, indicate the decision of whether the student is or is not eligible using the drop-down selection.

Check the Sources of Data Used to Make this Decision.
Enter the current IEP (Date) (MMDDYY) or click and select date.

Add any Other source of data used to make this decision that might apply.

Check Student to include the student's name as a participant. If the checkbox is left blank the name will not be included as a participant.
On the Parents section, check Participant, to include each parent/guardian name as a participant. If these are left blank, the names will not be included as participants.

The Staff section displays the staff members who have been added to the student’s Team List. Names can be added or removed from the staff section of this document without affecting the student’s Team List. If a Staff name is added to this document, the name will display on this document only and not on the student’s Team List. Staff Names displaying will be included as participants, however changes may be made including additional staff names added.

Change current staff names:

Click next to the Staff Name to change. The Find: Staff screen displays.
Enter all or part of staff Last Name, First Name.
Click or press ENTER. Search Results displays a list of matching criteria.
Click line of staff name. Line highlights.
Click again or click . Find: Staff screen closes and staff name displays.

Click the Role and select the staff role.

Add staff names:

Click on the Staff bar. A new line is added to the grid.
Repeat the procedure above.
If needed, check on the line of the staff name to remove. The row is removed.

The Other Participants section will allow for participant names that are not available in the Staff directory.

Click on the Other Participants bar. A new row will be added.
Enter the Name and Job Title of the participant.
If needed, check on the line of the staff name to remove. The row is removed.
Use to spellcheck.
Use for more space.
The Contact Person displays staff member names from the Staff Participants list. Select the appropriate staff participant's name to display as the Contact Person.
Enter that person's Phone number.
Click .
The document can be printed, validated and finalized.

GENAZ 63 Eligibility Determination - Orthopedic Impairment

The Eligibility Determination – Orthopedic Impairment contains one tab:

Eligibility Determination

To create an Eligibility Determination – Orthopedic Impairment document:

Enter the Document Date (MMDDYY) or click and select date. This should reflect the date the document was created.
Respond to the statements by selecting Yes or No from the drop-downs.
If either response is Yes, provide an explanation in the textbox.
Use to spellcheck.
Use for more space.

The Eligibility Criteria contains checkboxes that determine if the student meets the criteria for eligibility.

Check the appropriate Eligibility Criteria that apply.

Based on the criteria selected, indicate the decision of whether the student is or is not eligible using the drop-down selection.

Check the Sources of Data Used to Make this Decision.
Enter the current IEP (Date) (MMDDYY) or click and select date.

Add any Other source of data used to make this decision that might apply.

Check Student to include the student's name as a participant. If the checkbox is left blank the name will not be included as a participant.
On the Parents section, check Participant, to include each parent/guardian name as a participant. If these are left blank, the names will not be included as participants.

The Staff section displays the staff members who have been added to the student’s Team List. Names can be added or removed from the staff section of this document without affecting the student’s Team List. If a Staff name is added to this document, the name will display on this document only and not on the student’s Team List. Staff Names displaying will be included as participants, however changes may be made including additional staff names added.

Change current staff names:

Click next to the Staff Name to change. The Find: Staff screen displays.
Enter all or part of staff Last Name, First Name.
Click or press ENTER. Search Results displays a list of matching criteria.
Click line of staff name. Line highlights.
Click again or click . Find: Staff screen closes and staff name displays.

Click the Role and select the staff role.

Add staff names:

Click on the Staff bar. A new line is added to the grid.
Repeat the procedure above.
If needed, check on the line of the staff name to remove. The row is removed.

The Other Participants section will allow for participant names that are not available in the Staff directory.

Click on the Other Participants bar. A new row will be added.
Enter the Name and Job Title of the participant.
If needed, check on the line of the staff name to remove. The row is removed.
Use to spellcheck.
Use for more space.
The Contact Person displays staff member names from the Staff Participants list. Select the appropriate staff participant's name to display as the Contact Person.
Enter that person's Phone number.
Click .
The document can be printed, validated and finalized.

GENAZ 64A Eligibility Determination - Developmental Delay

The Eligibility Determination – Developmental Delay contains one tab:

Eligibility Determination

To create an Eligibility Determination – Developmental Delay document:

Enter the Document Date (MMDDYY) or click and select date. This should reflect the date the document was created.
Respond to the statements by selecting Yes or No from the drop-downs.
If either response is Yes, provide an explanation in the textbox.
Use to spellcheck.
Use for more space.

The Eligibility Criteria contains checkboxes that determine if the student meets the criteria for eligibility.

Check the appropriate Eligibility Criteria that apply.

Based on the criteria selected, indicate the decision of whether the student is or is not eligible using the drop-down selection.

Check the Sources of Data Used to Make this Decision.
Enter the current IEP (Date) (MMDDYY) or click and select date.

Add any Other source of data used to make this decision that might apply.

Check Student to include the student's name as a participant. If the checkbox is left blank the name will not be included as a participant.
On the Parents section, check Participant, to include each parent/guardian name as a participant. If these are left blank, the names will not be included as participants.

The Staff section displays the staff members who have been added to the student’s Team List. Names can be added or removed from the staff section of this document without affecting the student’s Team List. If a Staff name is added to this document, the name will display on this document only and not on the student’s Team List. Staff Names displaying will be included as participants, however changes may be made including additional staff names added.

Change current staff names:

Click next to the Staff Name to change. The Find: Staff screen displays.
Enter all or part of staff Last Name, First Name.
Click or press ENTER. Search Results displays a list of matching criteria.
Click line of staff name. Line highlights.
Click again or click . Find: Staff screen closes and staff name displays.

Click the Role and select the staff role.

Add staff names:

Click on the Staff bar. A new line is added to the grid.
Repeat the procedure above.
If needed, check on the line of the staff name to remove. The row is removed.

The Other Participants section will allow for participant names that are not available in the Staff directory.

Click on the Other Participants bar. A new row will be added.
Enter the Name and Job Title of the participant.
If needed, check on the line of the staff name to remove. The row is removed.
Use to spellcheck.
Use for more space.
The Contact Person displays staff member names from the Staff Participants list. Select the appropriate staff participant's name to display as the Contact Person.
Enter that person's Phone number.
Click .
The document can be printed, validated and finalized.

GENAZ 64 Eligibility Determination - Preschool Severe Delay

The Eligibility Determination – Preschool Severe Delay contains one tab:

Eligibility Determination

To create an Eligibility Determination – Preschool Severe Delay document:

Enter the Document Date (MMDDYY) or click and select date. This should reflect the date the document was created.
Respond to the statements by selecting Yes or No from the drop-downs.
If either response is Yes, provide an explanation in the textbox.
Use to spellcheck.
Use for more space.

The Eligibility Criteria contains checkboxes that determine if the student meets the criteria for eligibility.

Check the appropriate Eligibility Criteria that apply.

Based on the criteria selected, indicate the decision of whether the student is or is not eligible using the drop-down selection.

Check the Sources of Data Used to Make this Decision.
Enter the current IEP (Date) (MMDDYY) or click and select date.

Add any Other source of data used to make this decision that might apply.

Check Student to include the student's name as a participant. If the checkbox is left blank the name will not be included as a participant.
On the Parents section, check Participant, to include each parent/guardian name as a participant. If these are left blank, the names will not be included as participants.

The Staff section displays the staff members who have been added to the student’s Team List. Names can be added or removed from the staff section of this document without affecting the student’s Team List. If a Staff name is added to this document, the name will display on this document only and not on the student’s Team List. Staff Names displaying will be included as participants, however changes may be made including additional staff names added.

Change current staff names:

Click next to the Staff Name to change. The Find: Staff screen displays.
Enter all or part of staff Last Name, First Name.
Click or press ENTER. Search Results displays a list of matching criteria.
Click line of staff name. Line highlights.
Click again or click . Find: Staff screen closes and staff name displays.

Click the Role and select the staff role.

Add staff names:

Click on the Staff bar. A new line is added to the grid.
Repeat the procedure above.
If needed, check on the line of the staff name to remove. The row is removed.

The Other Participants section will allow for participant names that are not available in the Staff directory.

Click on the Other Participants bar. A new row will be added.
Enter the Name and Job Title of the participant.
If needed, check on the line of the staff name to remove. The row is removed.
Use to spellcheck.
Use for more space.
The Contact Person displays staff member names from the Staff Participants list. Select the appropriate staff participant's name to display as the Contact Person.
Enter that person's Phone number.
Click .
The document can be printed, validated and finalized.

GENAZ 65 Eligibility Determination - Specific Learning Disability

The Eligibility Determination – Specific Learning Disability contains one tab:

Eligibility Determination

To create an Eligibility Determination – Specific Learning Disability document:

Enter the Document Date (MMDDYY) or click and select date. This should reflect the date the document was created.
Respond to the statements by selecting Yes or No from the drop-downs.
If either response is Yes, provide an explanation in the textbox.
Use to spellcheck.
Use for more space.

The Eligibility Criteria contains checkboxes that determine if the student meets the criteria for eligibility.

Check the appropriate Eligibility Criteria that apply.

Based on the criteria selected, indicate the decision of whether the student is or is not eligible using the drop-down selection.

Check the Sources of Data Used to Make this Decision.
Enter the current IEP (Date) (MMDDYY) or click and select date.

Add any Other source of data used to make this decision that might apply.

Check Student to include the student's name as a participant. If the checkbox is left blank the name will not be included as a participant.
Click Student Decision and select whether the student Agrees or Disagrees with this eligibility determination.
Repeat this step for each parent participant, using the drop-down under the Agree/Disagree column.
On the Parents section, check Participant, to include each parent/guardian name as a participant. If these are left blank, the names will not be included as participants.

The Staff section displays the staff members who have been added to the student’s Team List. Names can be added or removed from the staff section of this document without affecting the student’s Team List. If a Staff name is added to this document, the name will display on this document only and not on the student’s Team List. Staff Names displaying will be included as participants, however changes may be made including additional staff names added.

For each staff participant, click Agree/Disagree and make the appropriate selection.

Change current staff names:

Click next to the Staff Name to change. The Find: Staff screen displays.
Enter all or part of staff Last Name, First Name.
Click or press ENTER. Search Results displays a list of matching criteria.
Click line of staff name. Line highlights.
Click again or click . Find: Staff screen closes and staff name displays.

Click the Role and select the staff role.
Click Agree/Disagree and make the appropriate selection.

Add staff names:

Click on the Staff bar. A new line is added to the grid.
Repeat the procedure above.
If needed, check on the line of the staff name to remove. The row is removed.

The Other Participants section will allow for participant names that are not available in the Staff directory.

Click on the Other Participants bar. A new row will be added.
Enter the Name and Job Title of the participant.
Click Agree/Disagree and make the appropriate selection.
If needed, check on the line of the staff name to remove. The row is removed.
Use to spellcheck.
Use for more space.
The Contact Person displays staff member names from the Staff Participants list. Select the appropriate staff participant's name to display as the Contact Person.
Enter that person's Phone number.
Click .
The document can be printed, validated and finalized.

GENAZ 66 Eligibility Determination - Speech/Language Impairment

The Eligibility Determination – Speech/Language Impairment contains one tab:

Eligibility Determination

To create an Eligibility Determination – Speech/Language Impairment document:

Enter the Document Date (MMDDYY) or click and select date. This should reflect the date the document was created.
Respond to the statements by selecting Yes or No from the drop-downs.
If either response is Yes, provide an explanation in the textbox.
Use to spellcheck.
Use for more space.

The Eligibility Criteria contains checkboxes that determine if the student meets the criteria for eligibility for language and another for speech.

Check the appropriate Eligibility Criteria that apply.

Based on the criteria selected, indicate the decision of whether the student is or is not eligible as a student with a language impairment, using the drop-down selection.
Based on the criteria selected, indicate the decision of whether the student is or is not eligible as a student with a speech impairment, using the drop-down selection.

A student may be eligible for none, one or both.

Check the Sources of Data Used to Make this Decision.
Enter the current IEP (Date) (MMDDYY) or click and select date.

Add any Other source of data used to make this decision that might apply.

Check Student to include the student's name as a participant. If the checkbox is left blank the name will not be included as a participant.
On the Parents section, check Participant, to include each parent/guardian name as a participant. If these are left blank, the names will not be included as participants.

The Staff section displays the staff members who have been added to the student’s Team List. Names can be added or removed from the staff section of this document without affecting the student’s Team List. If a Staff name is added to this document, the name will display on this document only and not on the student’s Team List. Staff Names displaying will be included as participants, however changes may be made including additional staff names added.

Change current staff names:

Click next to the Staff Name to change. The Find: Staff screen displays.
Enter all or part of staff Last Name, First Name.
Click or press ENTER. Search Results displays a list of matching criteria.
Click line of staff name. Line highlights.
Click again or click . Find: Staff screen closes and staff name displays.

Click the Role and select the staff role.

Add staff names:

Click on the Staff bar. A new line is added to the grid.
Repeat the procedure above.
If needed, check on the line of the staff name to remove. The row is removed.

The Other Participants section will allow for participant names that are not available in the Staff directory.

Click on the Other Participants bar. A new row will be added.
Enter the Name and Job Title of the participant.
If needed, check on the line of the staff name to remove. The row is removed.
Use to spellcheck.
Use for more space.
The Contact Person displays staff member names from the Staff Participants list. Select the appropriate staff participant's name to display as the Contact Person.
Enter that person's Phone number.
Click .
The document can be printed, validated and finalized.

GENAZ 67 Eligibility Determination - Traumatic Brain Injury

The Eligibility Determination – Traumatic Brain Injury contains one tab:

Eligibility Determination

To create an Eligibility Determination – Traumatic Brain Injury document:

Enter the Document Date (MMDDYY) or click and select date. This should reflect the date the document was created.
Respond to the statements by selecting Yes or No from the drop-downs.
If either response is Yes, provide an explanation in the textbox.
Use to spellcheck.
Use for more space.

The Eligibility Criteria contains checkboxes that determine if the student meets the criteria for eligibility.

Check the appropriate Eligibility Criteria that apply.

Based on the criteria selected, indicate the decision of whether the student is or is not eligible using the drop-down selection.

Check the Sources of Data Used to Make this Decision.
Enter the current IEP (Date) (MMDDYY) or click and select date.

Add any Other source of data used to make this decision that might apply.

Check Student to include the student's name as a participant. If the checkbox is left blank the name will not be included as a participant.
On the Parents section, check Participant, to include each parent/guardian name as a participant. If these are left blank, the names will not be included as participants.

The Staff section displays the staff members who have been added to the student’s Team List. Names can be added or removed from the staff section of this document without affecting the student’s Team List. If a Staff name is added to this document, the name will display on this document only and not on the student’s Team List. Staff Names displaying will be included as participants, however changes may be made including additional staff names added.

Change current staff names:

Click next to the Staff Name to change. The Find: Staff screen displays.
Enter all or part of staff Last Name, First Name.
Click or press ENTER. Search Results displays a list of matching criteria.
Click line of staff name. Line highlights.
Click again or click . Find: Staff screen closes and staff name displays.

Click the Role and select the staff role.

Add staff names:

Click on the Staff bar. A new line is added to the grid.
Repeat the procedure above.
If needed, check on the line of the staff name to remove. The row is removed.

The Other Participants section will allow for participant names that are not available in the Staff directory.

Click on the Other Participants bar. A new row will be added.
Enter the Name and Job Title of the participant.
If needed, check on the line of the staff name to remove. The row is removed.
Use to spellcheck.
Use for more space.
The Contact Person displays staff member names from the Staff Participants list. Select the appropriate staff participant's name to display as the Contact Person.
Enter that person's Phone number.
Click .
The document can be printed, validated and finalized.

GENAZ 68 Eligibility Determination - Visual Impairment

The Eligibility Determination – Visual Impairment contains one tab:

Eligibility Determination

To create an Eligibility Determination – Visual Impairment document:

Enter the Document Date (MMDDYY) or click and select date. This should reflect the date the document was created.
Respond to the statements by selecting Yes or No from the drop-downs.
If either response is Yes, provide an explanation in the textbox.
Use to spellcheck.
Use for more space.

The Eligibility Criteria contains checkboxes that determine if the student meets the criteria for eligibility.

Check the appropriate Eligibility Criteria that apply.

Based on the criteria selected, indicate the decision of whether the student is or is not eligible using the drop-down selection.

Check the Sources of Data Used to Make this Decision.
Enter the current IEP (Date) (MMDDYY) or click and select date.

Add any Other source of data used to make this decision that might apply.

Check Student to include the student's name as a participant. If the checkbox is left blank the name will not be included as a participant.
On the Parents section, check Participant, to include each parent/guardian name as a participant. If these are left blank, the names will not be included as participants.

The Staff section displays the staff members who have been added to the student’s Team List. Names can be added or removed from the staff section of this document without affecting the student’s Team List. If a Staff name is added to this document, the name will display on this document only and not on the student’s Team List. Staff Names displaying will be included as participants, however changes may be made including additional staff names added.

Change current staff names:

Click next to the Staff Name to change. The Find: Staff screen displays.
Enter all or part of staff Last Name, First Name.
Click or press ENTER. Search Results displays a list of matching criteria.
Click line of staff name. Line highlights.
Click again or click . Find: Staff screen closes and staff name displays.

Click the Role and select the staff role.

Add staff names:

Click on the Staff bar. A new line is added to the grid.
Repeat the procedure above.
If needed, check on the line of the staff name to remove. The row is removed.

The Other Participants section will allow for participant names that are not available in the Staff directory.

Click on the Other Participants bar. A new row will be added.
Enter the Name and Job Title of the participant.
If needed, check on the line of the staff name to remove. The row is removed.
Use to spellcheck.
Use for more space.
The Contact Person displays staff member names from the Staff Participants list. Select the appropriate staff participant's name to display as the Contact Person.
Enter that person's Phone number.
Click .
The document can be printed, validated and finalized.

GENAZ 69 Eligibility Determination - Non Eligible Child

The Eligibility Determination – Non Eligible Child contains one tab:

Eligibility Determination

To create an Eligibility Determination – Non Eligible Child document:

Enter the Document Date (MMDDYY) or click and select date. This should reflect the date the document was created.
Respond to the statements by selecting Yes or No from the drop-downs.
If either response is Yes, provide an explanation in the textbox.
Use to spellcheck.
Use for more space.

The Eligibility Criteria contains checkboxes that determine if the student meets the criteria for eligibility.

Check the appropriate Eligibility Criteria that apply.

Based on the criteria selected, indicate the decision of whether the student is or is not eligible using the drop-down selection.

Check the Sources of Data Used to Make this Decision.
Enter the current IEP (Date) (MMDDYY) or click and select date.

Add any Other source of data used to make this decision that might apply.

Check Student to include the student's name as a participant. If the checkbox is left blank the name will not be included as a participant.
On the Parents section, check Participant, to include each parent/guardian name as a participant. If these are left blank, the names will not be included as participants.

The Staff section displays the staff members who have been added to the student’s Team List. Names can be added or removed from the staff section of this document without affecting the student’s Team List. If a Staff name is added to this document, the name will display on this document only and not on the student’s Team List. Staff Names displaying will be included as participants, however changes may be made including additional staff names added.

Change current staff names:

Click next to the Staff Name to change. The Find: Staff screen displays.
Enter all or part of staff Last Name, First Name.
Click or press ENTER. Search Results displays a list of matching criteria.
Click line of staff name. Line highlights.
Click again or click . Find: Staff screen closes and staff name displays.

Click the Role and select the staff role.

Add staff names:

Click on the Staff bar. A new line is added to the grid.
Repeat the procedure above.
If needed, check on the line of the staff name to remove. The row is removed.

The Other Participants section will allow for participant names that are not available in the Staff directory.

Click on the Other Participants bar. A new row will be added.
Enter the Name and Job Title of the participant.
If needed, check on the line of the staff name to remove. The row is removed.
Use to spellcheck.
Use for more space.
The Contact Person displays staff member names from the Staff Participants list. Select the appropriate staff participant's name to display as the Contact Person.
Enter that person's Phone number.
Click .
The document can be printed, validated and finalized.

Eligibility Determination Documents

The list of Eligibility Determination documents can be accessed from the Portfolio screen by clicking on the “E” icon in the Initial, Reevaluation or Preschool Process. In the SE Student screen on the Process Docs tab, click the icon on the line of Eligibility Docs.

NOTE: Eligibility Determination documents have been created from the Eligibility Determination Template in Synergy SE. The wording of the examples may differ as each school district has the ability to create and edit these documents to meet their individual district needs.

GENAZ 56 Eligibility Determination - Autism

The Eligibility Determination – Autism contains one tab:

Eligibility Determination

To create an Eligibility Determination – Autism document:

Enter the Document Date (MMDDYY) or click and select date. This should reflect the date the document was created.

Respond to the statements by selecting Yes or No from the drop-downs.

If either response is Yes, provide an explanation in the textbox.

Use to spellcheck.

Use for more space.

The Eligibility Criteria contains checkboxes that determine if the student meets the criteria for eligibility.

Check the appropriate Eligibility Criteria that apply.

Based on the criteria selected, indicate the decision of whether the student is or is not eligible using the drop-down selection.

Check the Sources of Data Used to Make this Decision.

Enter the current IEP (Date) (MMDDYY) or click and select date.

Add any Other source of data used to make this decision that might apply.

Check Student to include the student's name as a participant. If the checkbox is left blank the name will not be included as a participant.

On the Parents section, check Participant, to include each parent/guardian name as a participant. If these are left blank, the names will not be included as participants.

Change current staff names:

Click next to the Staff Name to change. The Find: Staff screen displays.

Enter all or part of staff Last Name, First Name.

Click or press ENTER. Search Results displays a list of matching criteria.

Click line of staff name. Line highlights.

Click again or click . Find: Staff screen closes and staff name displays.

Click the Role and select the staff role.

Add staff names:

Click on the Staff bar. A new line is added to the grid.

Repeat the procedure above.

If needed, check on the line of the staff name to remove. The row is removed.

The Other Participants section will allow for participant names that are not available in the Staff directory.

Click on the Other Participants bar. A new row will be added.

Enter the Name and Job Title of the participant.

If needed, check on the line of the staff name to remove. The row is removed.

Use to spellcheck.

Use for more space.

The Contact Person displays staff member names from the Staff Participants list. Select the appropriate staff participant's name to display as the Contact Person.

Enter that person's Phone number.

The final section contains the DSM-IV Diagnostic Criteria for Autism Spectrum Disorder. Based on selections checked, the student is given a score that will provide an overview and explanation of the student’s Autism eligibility.

Check the statements that apply. The Total box at the bottom, displays the amount of items selected.

Click .

The document can be printed, validated and finalized.

GENAZ 57 Eligibility Determination - Emotional Disability

The Eligibility Determination – Emotional Disability contains one tab:

Eligibility Determination

To create an Eligibility Determination – Emotional Disability document:

Enter the Document Date (MMDDYY) or click and select date. This should reflect the date the document was created.

Respond to the statements by selecting Yes or No from the drop-downs.

If either response is Yes, provide an explanation in the textbox.

Use to spellcheck.

Use for more space.

The Eligibility Criteria contains checkboxes that determine if the student meets the criteria for eligibility.

Check the appropriate Eligibility Criteria that apply.

Based on the criteria selected, indicate the decision of whether the student is or is not eligible using the drop-down selection.

Check the Sources of Data Used to Make this Decision.

Enter the current IEP (Date) (MMDDYY) or click and select date.

Add any Other source of data used to make this decision that might apply.

Check Student to include the student's name as a participant. If the checkbox is left blank the name will not be included as a participant.

On the Parents section, check Participant, to include each parent/guardian name as a participant. If these are left blank, the names will not be included as participants.

Change current staff names:

Click next to the Staff Name to change. The Find: Staff screen displays.

Enter all or part of staff Last Name, First Name.

Click or press ENTER. Search Results displays a list of matching criteria.

Click line of staff name. Line highlights.

Click again or click . Find: Staff screen closes and staff name displays.

Click the Role and select the staff role.

Add staff names:

Click on the Staff bar. A new line is added to the grid.

Repeat the procedure above.

If needed, check on the line of the staff name to remove. The row is removed.

The Other Participants section will allow for participant names that are not available in the Staff directory.

Click on the Other Participants bar. A new row will be added.

Enter the Name and Job Title of the participant.

If needed, check on the line of the staff name to remove. The row is removed.

Use to spellcheck.

Use for more space.

The Contact Person displays staff member names from the Staff Participants list. Select the appropriate staff participant's name to display as the Contact Person.

Enter that person's Phone number.

Click .